From Conceptions to Capacity: A phenomenographic study of health personnel and their conceptions of child sexual abuse and health services in Esteli, Nicaragua

Child sexual abuse (CSA) is a significant public health problem with serious consequences for human and socioeconomic development. In Nicaragua there is a dearth of information about CSA in relation to the health sector. The purpose of this study was to assess the Nicaraguan health sector’s most fundamental capacity to respond to CSA, by way of investigating the conceptions constituted amongst health personnel in regards to CSA and CSA health services. The study was guided by phenomenography, a qualitative research approach used to reveal and describe conceptions from a second-order perspective. Twenty-three semi-structured interviews were conducted with governmental and non-governmental health personnel in the Nicaraguan city of Estelí. They revealed that interviewees conceptualized CSA as Pathology, Crime and Devastation. The same personnel conceptualized CSA services as Extraneous specialty, Desired specialty, Professional duty and Human duty. The interviewee sample was found to demonstrate desire and will to serve CSA survivors, although further training was required. The two sets of conceptions were consolidated to form a framework for understanding health personnel conceptions of CSA and CSA services. This framework should be useful for future health sector decisions, particularly regarding the promotion, design and evaluation of future CSA training for health personnel